Generalized bullous fixed drug eruption explained

Synonyms:Bullous drug eruption,[1] multilocular bullous fixed drug eruption
Field:Dermatology

Generalized bullous fixed drug eruption (GBFDE) most commonly refers to a drug reaction in the erythema multiforme group.[2] These are uncommon reactions to medications, with an incidence of 0.4 to 1.2 per million person-years for toxic epidermal necrolysis and 1.2 to 6.0 per million person-years for Stevens–Johnson syndrome. The primary skin lesions are large erythemas (faintly discernible even after confluence), most often irregularly distributed and of a characteristic purplish-livid color, at times with flaccid blisters.[3]

Signs and symptoms

A rare and severe variation of fixed drug eruption, generalized bullous fixed drug eruption involves blisters and erosions involving at least 10% of the body's surface area, affecting three of the six anatomic sites: the head and neck, the anterior and posterior trunk, the upper and lower extremities, and the genitalia.[4]

Causes

Fixed drug eruptions are linked to anti-infective (ß-lactam antibiotics, tinidazole, and acyclovir), analgesics (acetaminophen (paracetamol), mefenamic acid, and metamizole), non-steroidal anti-inflammatory drugs (NSAIDs), anti-epileptic (carbamazepine), psychoactive (barbiturates, codeine, and others), and other miscellaneous medications (omeprazole, contrast media, loratadine, and allopurinol).[4]

Diagnosis

In cases where the clinical presentation is unclear, a skin biopsy may be necessary to confirm the diagnosis of GBFDE. A subepidermal blister or denuded epidermis, vacuolar alterations at the dermo-epidermal junction, and a variable number of necrotic keratinocytes within the lesional intact epidermis are characteristic histopathologic findings of GBFDE.[5]

Treatment

Antihistamines and topical steroids are used in symptomatic therapy. Antibiotics should be given if an infection is thought to be present.[6] It is also important to counsel the patient to stay away from the offending medication.[7]

See also

Further reading

External links

Notes and References

  1. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 470 . 978-1-4160-2999-1 .
  2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. .
  3. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. .
  4. Paulmann . Maren . Reinkemeier . Felix . Lehnhardt . Marcus . Mockenhaupt . Maja . Case report: Generalized bullous fixed drug eruption mimicking epidermal necrolysis . Frontiers in Medicine . Frontiers Media SA . 10 . August 14, 2023 . 2296-858X . 10.3389/fmed.2023.1125754 . free . 37644986 . 10461315 .
  5. Anderson . Hannah J. . Lee . Jason B. . A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption . Medicina . MDPI AG . 57 . 9 . September 1, 2021 . 1648-9144 . 10.3390/medicina57090925 . free . 925. 34577848 . 8468217 .
  6. Girisha . BanavasiShanmukha . Noronha . TonitaMariola . Alva . AkshataCharan . Menon . Ashok . Generalized bullous fixed drug eruption mimicking toxic epidermal necrolysis caused by paracetamol . Clinical Dermatology Review . Medknow . 2 . 1 . 2018 . 2542-551X . 10.4103/cdr.cdr_25_17 . free . 34.
  7. Das . Anupam . Podder . Indrashis . Chandra . Somodyuti . Gharami . RameshChandra . Doxycycline induced generalized bullous fixed drug eruption . Indian Journal of Dermatology . Medknow . 61 . 1 . 2016 . 0019-5154 . 10.4103/0019-5154.174197 . free . 128. 26955169 . 4763688 .

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